AccountId: 011433970860
ContactId: 9f072b4c-6f7c-4e7b-85df-a1822f9f6055
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347500 ms
Total Talk Time (AGENT): 183541 ms
Total Talk Time (CUSTOMER): 116530 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/9f072b4c-6f7c-4e7b-85df-a1822f9f6055_20250402T18:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help?
[CUSTOMER][NEUTRAL] Yes ma'am [PII], I'm calling to verify the correct claims mailing address to submit claims if you could help me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you're just needing to verify the correct mailing address to send claims to APL for a member.
[CUSTOMER][NEUTRAL] Yes ma'am, uh, because it looks like, yes ma'am, because I think it looks like we've got an old address listed, so we're trying to, we received return mail on some of our claims that was filed, um, so I'm just trying to verify the correct information to update the system.
[AGENT][NEUTRAL] Is that right? Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Sure, yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My first name is [PII]. Last initial is [PII] and I'm calling from the provider.
[AGENT][POSITIVE] OK thank you
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Sure and what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's a good callback number for you?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. So now, [PII], depending upon the type of plan that the member has as to what the claims PO box would be, do you have a policy number for one of the patients?
[CUSTOMER][NEUTRAL] I do have a policy number um I've got a copy of the card here the patient turned in.
[AGENT][NEUTRAL] OK, that's fine. What is that policy?
[CUSTOMER][NEUTRAL] It looks like the card number 017.
[CUSTOMER][NEUTRAL] 352-73
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you, give me just a moment to get that member's information pulled up.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification on benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so yes ma'am, he is a subscriber on the supplemental policy. OK, so on this policy now the.
[AGENT][NEUTRAL] Policy number that you provided for me, [PII], policy was active from [PII].
[AGENT][NEUTRAL] To [PII]. Now, he does have another policy that is currently active, but it is a different policy.
[CUSTOMER][NEUTRAL] OK. So he
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] His current active policy number is 25.
[AGENT][NEUTRAL] 00.
[AGENT][NEUTRAL] 293.
[AGENT][NEUTRAL] And this policy became effective as of [PII] and it is still active.
[CUSTOMER][POSITIVE] OK, thank you for that information.
[AGENT][NEUTRAL] Or does your date of service. You're welcome. Does your date of service fall within the
[CUSTOMER][NEUTRAL] Uh, yeah, the date is.
[AGENT][NEUTRAL] For the active policy.
[CUSTOMER][NEUTRAL] Yes ma'am, it's for [PII].
[AGENT][NEUTRAL] OK, so yes ma'am, use that 2nd number.
[CUSTOMER][NEUTRAL] Yeah he just give us a copy of an old card, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When you file the claim?
[CUSTOMER][NEUTRAL] And what's the address?
[AGENT][NEUTRAL] It is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and do you guys receive uh claims electronically?
[AGENT][NEUTRAL] We do, we have our payer ID is 60801.
[AGENT][NEUTRAL] And on this type of policy, [PII], when the claim is filed with us, we do have to have a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well and then now we have a portal that you should be able to check claim status in once we have processed the claim by going to secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the portal OK.
[AGENT][NEUTRAL] Yes, ma'am, uh-huh.
[CUSTOMER][NEUTRAL] OK, so, and then you guys um do need a copy of the EFB probably even if we submitted electronically we're still gonna have to submit it hard copy with a copy of the primary attached, correct?
[AGENT][NEUTRAL] Yes, on this type of policy since it's designed to help with his co-pays, deductibles and co-insurance amounts, we have to have that primary EOB for review as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. All right, and I guess just um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you guys have caller reference numbers [PII] or just your name in today's date?
[AGENT][NEUTRAL] That's it. My name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] Well, you're certainly so welcome. And is there anything else I could?
[CUSTOMER][POSITIVE] And have a good rest of your day.
[AGENT][POSITIVE] Oh, well, I hope you do too. So thank you again for calling ATS.
[CUSTOMER][NEUTRAL] No ma'am, that'll be all.
[CUSTOMER][POSITIVE] Thank you, ma'am. Bye-bye.
[AGENT][NEUTRAL] OK. Well, again, you're welcome. Bye-bye.